A Phase II Redifferentiation Trial with Dabrafenib-Trametinib and 131I in Metastatic Radioactive Iodine Refractory BRAF p.V600E-Mutated Differentiated Thyroid Cancer.

Abstract

PURPOSE:

To evaluate the efficacy and safety of dabrafenib-trametinib-131I for the treatment of radioactive iodine refractory metastatic differentiated thyroid cancer (DTC) with a BRAF p.V600E mutation.

PATIENTS AND METHODS:

A prospective phase II trial including patients with RECIST progression within 18 months and no lesion > 3 cm. Following a baseline recombinant human (rh)TSH-stimulated diagnostic whole-body scan (dc1-WBS), dabrafenib and trametinib were given for 42 days. A second rhTSH-stimulated dc WBS (dc2-WBS) was done at day 28 and 131I (5.5 GBq-150 mCi after rhTSH) was administered at day 35. Primary endpoint was the 6-month RECIST objective response rate. In case of partial response (PR) at 6 or 12 months, a second treatment course could be given. Among 24 enrolled patients, 21 were evaluable at 6 months.

RESULTS:

Abnormal 131I uptake was present on 5%, 65%, and 95% of the dc1-WBS, dc2-WBS, and post-therapy scans, respectively. At 6 months, PR was achieved in 38%, stable disease in 52%, and progressive disease (PD) in 10%. Ten patients received a second treatment course: one complete response and 6 PRs were observed at 6 months. The median progression-free survival (PFS) was not reached. The 12- and 24-month PFS were 82% and 68%, respectively. One death due to PD occurred at 24 months. Adverse events (AE) occurred in 96% of the patients, with 10 grade 3-4 AEs in 7 patients.

CONCLUSIONS:

Dabrafenib-trametinib is effective in BRAF p.V600E-mutated DTC patients for restoring 131I uptake with PR observed 6 months after 131I administration in 38% of the patients.

• Authors: Sophie Leboulleux, Christine Do Cao, Slimane Zerdoud, Marie Attard, Claire Bournaud, Ludovic Lacroix, Danielle Benisvy, David Taïeb, Stéphane Bardet, Marie Terroir-Cassou-Mounat, Nadège Anizan, Emilie Bouvier-Morel, Livia Lamartina, Georges Lion, Sarah Betrian, Christophe Sajous, Aurélie Schiazza, Marie-Eve Garcia, Renaud Ciappuccini, Martin Schlumberger, Abir Al Ghuzlan, Yann Godbert, Isabelle Borget
• Journal: Clinical cancer research : an official journal of the American Association for Cancer Research (Clin Cancer Res) Vol. 29 Issue 13 Pg. 2401-2409 (07 05 2023) ISSN: 1557-3265 [Electronic] United States
• PMID: 37074727 (Publication Type: Clinical Trial, Phase II, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: ©2023 American Association for Cancer Research.

Chemical References

• Iodine-131
• Iodine Radioisotopes
• trametinib
• dabrafenib
• Proto-Oncogene Proteins B-raf
• Thyrotropin Alfa
• Pyridones
• Pyrimidinones
• Oximes
• BRAF protein, human

Topics

• Humans
• Thyroid Neoplasms (drug therapy, genetics)
• Iodine Radioisotopes (adverse effects)
• Proto-Oncogene Proteins B-raf (genetics)
• Thyrotropin Alfa
• Prospective Studies
• Pyridones (adverse effects)
• Pyrimidinones
• Oximes (adverse effects)
• Adenocarcinoma (etiology)
• Antineoplastic Combined Chemotherapy Protocols (adverse effects)
• Mutation